title: Validation and attempts of revision of the MDS-recommended tests for the screening of Parkinson's disease dementia.
abstract: The Movement Disorders Society (MDS) formulated diagnostic criteria and assessment guidelines for the screening of dementia in Parkinson's disease (PD). We carried out a validation of the cognitive measures suggested in the screening algorithm (i.e. the Mini Mental State Examination - MMSE - total score, serial 7s subtraction, 3-word recall, pentagons copy, and one minute letter fluency) in 86 patients with PD. Thirty-six percent of participants were diagnosed with dementia using the MDS algorithm, but with the Dementia Rating Scale instead of the MMSE. The original MDS procedure misclassified 11 patients (12.8%) as false negatives and 3 (3.5%) as false positives, leading to 65% sensitivity and 95% specificity. The main reason for misdiagnoses was insensitivity of the MMSE total score. Three attempts were made to reach a better screening performance, which warrants high sensitivity more than high specificity: 1. exclusion of the MMSE total score as a diagnostic requirement; 2. determination of a better cut off through Receiver Operating Characteristic curve analysis; 3. replacement of the MMSE with the equally undemanding, but more PD-specific, Mini Mental Parkinson. The first two strategies generally yielded high sensitivity, but poor specificity. The best outcome was achieved using a Mini Mental Parkinson total score <27 as cognitive criterion: sensitivity was 87% and negative predictive value was 90%; however, specificity was only 67%. Our findings seem to suggest that MDS practical guidelines are specific, but might benefit from the use of more PD-oriented tools than the MMSE in terms of sensitivity.
authors.affiliation: Neurology Section, S. Gerardo Hospital, University of Milan Bicocca, Monza, Italy. Electronic address: valeria.isella@unimib.it.
authors.forename: V
authors.initials: V
authors.lastname: Isella
authors.affiliation: Neurology Section, S. Gerardo Hospital, University of Milan Bicocca, Monza, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Mapelli
authors.affiliation: Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Siri
authors.affiliation: Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: De Gaspari
authors.affiliation: Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pezzoli
authors.affiliation: Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy; Department of Neurology, IRCCS San Camillo, University of Padua, Venice, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Antonini
authors.affiliation: Department of Neuroscience, University of Pisa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Poletti
authors.affiliation: Department of Neuroscience, University of Pisa, Italy.
authors.forename: U
authors.initials: U
authors.lastname: Bonuccelli
authors.affiliation: Neurology Section, Campo di Marte Hospital, Lucca, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Vista
authors.affiliation: Neurology Section, S. Gerardo Hospital, University of Milan Bicocca, Monza, Italy.
authors.forename: I M
authors.initials: IM
authors.lastname: Appollonio
mesh_terms: D000368:Aged; D000465:Algorithms; D003704:Dementia / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards*; D010300:Parkinson Disease / Q000150:complications / Q000523:psychology*; D012372:ROC Curve; D012680:Sensitivity and Specificity
keywords: MDS guidelines; Mini Mental Parkinson; Mini Mental State Examination; Parkinson's disease dementia